Chase Cover Order Form

"*" indicates required fields

Name*

First Last

Email

Phone

Purchase Order Number

Material

Stainless

Vertical Skirt with Drip Edge

2"

3"

4"

5"

6"

Other

If Other, which height (Measured in inches)

Collar Height (inches)

2"

3"

4" (Standard)

Other

If Other, which height (Measured in inches)

Collar Diameter (inches)

6"

8"

10"

12"

Other

If Other, how many inches?

Storm Collar Needed?

Yes

No

If Yes, which size?

Number of Collars

1, centered

1, not centered

2

Other

If Other, how many?

Please list the total width of the cover in inches (shorter side).

Please list the total width of the cover in inches (longer side).

Additional Information

Consent*

I agree to the privacy policy.

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